Cardiovascular health is a leading concern around the world. Diseases and disorders ranging from rheumatic heart disease, hypertensive heart disease, ischemic heart disease, cerebrovascular disease and inflammatory heart disease constitute a primary cause of death in both developed and underdeveloped nations. As an advocate of putting cardiovascular disease and its risk factors on the global health agenda, the World Heart Federation strongly supports initiatives addressing obesity, healthy diet and physical activity.
Hypertensive disease generally refers to high blood pressure of unknown origin (primary hypertension) or caused by (secondary hypertension) certain specific diseases or infections, such as tumor in the adrenal glands, damage to or disease of the kidneys or their blood vessels. High blood pressure may overburden the heart and blood vessels and cause disease.
Blood pressure is the force of blood against artery walls as it circulates through the human body. Blood pressure normally rises and falls throughout the day, but it can cause health problems if it stays high for a long time. High blood pressure is sometimes called the “silent killer” because it usually has no warning signs or symptoms: many people do not know that they have high blood pressure, hence the recommendation to have blood pressure checked regularly. According to the CDC, about 70 million American adults (29%) have high blood pressure: that is 1 in every 3 American adults. (Nwankwo T, et al. Hypertension among adults in the US: National Health and Nutrition Examination Survey, 2011-2012. NCHS Data Brief, No. 133. Hyattsville, Md.: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2013). Anyone, including children, can develop high blood pressure. It greatly increases the risk for heart disease and stroke, the first and third leading causes of death in the United States. Blood pressure is an underlying cause of heart attacks, strokes and kidney disease, and the prevalence of high blood pressure is so high, it is considered the single-largest contributor to death worldwide. It is also becoming more resistant to the pharmaceutical drugs used to lower it. In fact, blood pressure remains elevated in nearly one-third of all treated hypertensive patients on pharmaceutical drugs.
Instead of relying on prescriptions, more patients are turning to a healthier eating approach: Keeping sodium intake low and making consumption of nitric oxide-rich vegetables and leafy greens high. This cardio-protective daily diet, known as the DASH (Dietary Approach to Stop Hypertension) Eating Plan, is emerging as an effective way to delay or prevent high blood pressure altogether.
The value of nitric oxide was spotlighted when the Nobel Prize was awarded in 1998 for discovery of this naturally produced cardio-protective factor. A string of clinical studies underscored that vegetables (like red beet roots) and leafy greens (such as spinach and arugula) are replete with nitric oxide. Diets known for promoting heart health and lowering rates of diabetes and obesity, like Japanese diets, Mediterranean diets and plant-based diets, such as DASH, among others including TLC, Ornish, and Mayo, incorporate these natural whole foods. Nitric oxide is emerging as a critically important cardioprotective and vascular wellness factor. With age, arteries lose their elasticity and ability to make nitric oxide to prevent cardiovascular disease. Scientific evidence suggests that vascular aging may be delayed through the increased production of nitric oxide, thereby, enhancing cardiovascular function. Athletes have already taken advantage of these discoveries by increasing their consumption of leafy greens and beetroots, both of which are rich in nitrate, to elevate nitric oxide levels that increase endurance and performance.
A recent study (Apr. 15, 2013) conducted by researchers from Queen Mary University of London, and published in the American Heart Association Journal, Hypertension, provides further support for the importance of nitric oxide and of the blood pressure lowering effects on nitrate-rich vegetables. (Enhanced vasodilator activity of nitrite in hypertension: critical role for erythrocytic xanthine oxidoreductase and translational potential. Ghosh S M et al. Hypertension. 2013 May; 61(5):1091-102. Subjects who drank beetroot juice containing a natural source of inorganic nitrate show an average 10-point decrease in their blood pressure. Sustaining such levels may be critical in maintaining normal blood pressure. The lead author, Dr. Ahiuwalia, reported to Medical Xpress: “our hope is that increasing one's intake of vegetables with a high dietary nitrate content, such as green leafy vegetables or beet root, might be a lifestyle approach that one could easily employ to improve cardiovascular health.”
Reducing hypertension would not only improve health outcomes for individual patients, but would also benefit the health system as a whole. Although the percentage of resistance to antihypertensive drugs is relatively lower in the U.S., elevated blood pressure among a rapidly growing number of baby boomers will mean more challenges for health care in the long run unless appropriate measures and lifestyle changes are designed in put in place. Poor diet and physical inactivity remain the primary drivers of cardiovascular disease and metabolic disorders such as gout, obesity, hypertension, and diabetic insulin resistance. A daily lifestyle of a cardioprotective diet, including nitrate-rich plant-based foods, is a solution. More specifically, the amino acid, arginine can be a source for the body to make nitric oxide. Unfortunately, the aging process results in the loss our ability to make nitric oxide through the use of arginine, thereby increasing reliance on a non-arginine source, specifically, dietary nitrate. Plant-based foods, such as the DASH Diet, rich in leafy greens such as arugula, kale, and spinach, help supplement the body's pool of nitrate, which can be converted to nitric oxide, independent of arginine.
DASH holds great promise to fuel compliance, a critical driver to prevent elevated blood pressure, among those living with hypertension. Athletes have already taken advantage of these discoveries by increasing the consumption of nitrate-rich beetroot juices to elevate nitric oxide levels which increases endurance and performance. A growing number of athletes are now validating the nitric oxide potency of their beet juice and modifying their training diets to optimize performance.
But a healthful eating strategy alone will not mean better outcomes for patients without a model to help them break bad habits and support dietary changes on a personal level, one day at a time. Indeed even if individuals and communities have a commitment to healthy diets, the necessary resources may not be readily available due to economics or convenience. For example, some communities may be described as ‘food deserts’, defined as a region vapid of fresh fruit, vegetables, and other healthful whole foods; often times such food deserts are found in impoverished areas. In other situations, individuals may need to rely on convenience food to ensure sufficient intake of nitrate-rich nutrition, and in such situations it would be useful to have access to nutritional supplements that easy to ingest, transport and store.
What is needed therefore, is nitrate rich dietary supplement. Such supplements should be compatible with day to day conveniences, they should be easy to ingest and they should be palatable. In addition, such supplements should be affordable and preferably derived from natural ingredients.